Primary care practices are full of surprises!

Primary care practices are complex adaptive systems facing the need to respond to internal and external uncertainty and surprise. For clinicians and practices to maximize their ability to proactively evolve as they respond to uncertainty and surprise, they need to understand that their practices are nonlinear systems and create the time and space for learning and reflection. This article provides principles for clinicians and staff for negotiating uncertainty and surprise in an ever-changing health care environment.